McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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What is a diaphragm?

A vaginal diaphragm is a soft, rubber dome stretched over a flexible ring. It is one of the barrier methods of birth control for women. Before sexual intercourse, you put some spermicide in the diaphragm. Then you insert the diaphragm into the vagina. The diaphragm blocks most sperm from entering the cervix, which is the opening of the uterus. The spermicide in the diaphragm destroys any sperm that may get around and into the diaphragm.

Several sizes and types of diaphragms are available. Each woman's body requires special measurement and fitting by a medical professional to make sure that the diaphragm fits correctly.

How is it used?

The diaphragm can be put into the vagina up to 3 hours before intercourse. Each time before you use it, hold the diaphragm up to a light and look closely for any tears, holes, or weak spots. Before you insert the diaphragm, you must put spermicidal jelly or cream in the middle and around the rim of the diaphragm.

The physical position you use for inserting the diaphragm depends on your preference. The positions usually suggested are:

• lying on your back with your knees up
• stooping with your knees bent and wide apart
• standing with one leg propped up on a stool or chair with your knees slightly bent.

Gently hold back the lips of the vagina. Fold the diaphragm in half and insert it dome-side down into the vagina. (If you have difficulty with the insertion, ask a medical professional for a plastic inserter, which makes insertion easier.) Position the diaphragm with the back of the rim fitting behind the cervix and the front part of the rim resting against the upper edge of your pubic bone. Check to see if the diaphragm is covering the whole cervix. You can do this by pressing your index finger against the dome and feeling the cervix underneath it. The cervix feels like the top of a hard pear without the stem. You can also run your finger around the rim to confirm that it is firmly in place. If you feel any discomfort after inserting the diaphragm, it may not be in the proper position. Remove the diaphragm and reinsert it so that it is comfortable.

You must leave the diaphragm in place for 6 to 8 hours after having sex so that the spermicide can destroy all of the sperm. If you are going to have sex again within this 6-hour period, do not remove the diaphragm. Put more spermicide into the vagina using the plastic applicator that comes with the spermicide. To have intercourse safely again after 6 hours, remove the diaphragm, wash it with soap and water. Coat the diaphragm again with spermicide and then reinsert it.

To take out the diaphragm, pull the rim (usually the upper rim) gently with your index finger and remove it from the vagina. After each use, wash and dry the diaphragm. Store it in a dry container.

It is a good idea to urinate before you insert the diaphragm and after you take it out. This helps reduce the chance of getting an infection in the bladder.

You should get a new diaphragm every 1 to 2 years.

What are the benefits?

The diaphragm has several benefits, such as:

• It is one of the most reliable (90% to 95%) barrier methods of birth control if it is well fitted and properly used.
• It helps reduce the risk of some sexually transmitted diseases. However, it does not protect against sexual transmission of AIDS unless your male partner also uses a latex condom.
• It is reusable and relatively inexpensive.
• It is small and easy to carry.

What are the disadvantages?

Some of the disadvantages of a diaphragm are:

• A prescription is required from a medical professional.
• If it is not correctly fitted, it may cause discomfort and possibly a urinary tract infection.
• Practice is needed to become comfortable and skilled in using a diaphragm.
• It can be inconvenient to use, clean, and store.
• You must keep a supply of spermicidal jelly or cream on hand at all times.
• In some cases an allergic reaction to the rubber or spermicide causes a sensation of burning, itching, redness, or a discharge from the vagina.
• Reexamination by a medical professional is necessary after pregnancy, abortion, pelvic surgery, or significant weight loss or gain (more than 20 pounds). The size of the diaphragm may need to be changed so that it fits correctly.
• Some women may not be able to use a diaphragm because of changes in their body structure (for example, after childbirth).
• It may (rarely) cause discomfort and reduce pleasure during intercourse.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.